The hazardous impacts of multiple repeated cesarean deliveries on adhesion formation and obstetric outcomes

Aim: The aim of this study was to determine whether the impact of repeat cesarean deliveries (CD) and abdominal adhesions onmaternal and fetal complications exists in patients with a history of one previous CD and ones with three or more prior CD.Material and Methods: A total of one hundred-one pregnant women with a history of at least one previous CD were included in thisprospective observational study. Participants were divided into two groups, patients with a single CD were added to the control group(n=56) and patients with a history of three or more CD were included in the study group (n=45). Preoperative scar characteristics andhemoglobin levels, intraoperative adhesion severity and grade were evaluated by using Linsky and Nair classifications for adhesion.In addition, duration of surgery, maternal complications and fetal status by using APGAR scoring system was analyzed, respectively.Results: Demographic features were comparable between the groups. The differences among the groups were found to be statisticallysignificant in terms of adhesion intensity and grade (1.13 vs 0.42, p

PDF

___

1. Bates GW Jr, Shomento S. Adhesion prevention in patients with multiple cesarean deliveries. Am J Obstet Gynecol 2011;205:19-24.
2. Gregory KD, Jackson S, Korst L, et al. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol 2012;29:7-18.
3. Cook JR, Jarvis S, Knight M, et al. Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study. BJOG 2013;120:85-91.
4. Tulandi T, Agdi M, Zarei A, et al. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 2009;201:1-6.
5. Diamond MP, Wexner SD, diZereg GS, et al. Adhesion prevention and reduction: current status and future recommendations of a multinational interdisciplinary consensus conference. Surg Innov 2010;17:183-8.
6. Lyell DJ. Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol 2011;205:11-8.
7. Stark M, Hoyme UB, Stubert B, et al. Post-cesarean adhesions-are they a unique entity? J Matern Fetal Neonatal Med 2008;21:513-6.
8. Pschera H, Kjaeldgaard A, Larsson B. Fibrinolytic activity in amniotic fluid during late pregnancy. Acta Obstet Gynecol Scand 1986;65:417-20.
9. Uyanikoglu H, Karahan MA, Turp AB, et al. Are multiple repeated cesarean sections really as safe? J Matern Fetal Neonatal Med 2017;30:482-5.
10. Alshehri KA, Ammar AA, Aldhubabian MA, et al. Outcomes and complications after repeat cesarean sections among King Abdulaziz University Hospital patients. Mater Sociomed 2019;31:119-24.
11. Kan O, Alkilic A. Relationship between scar characteristics and intraperitoneal adhesions in repeated cesarean deliveries. Bozok Med J 2019;9:97- 101.
12. Nair SK, Bhat IK, Aurora AL. Role of proteolytic enzyme in the prevention of postoperative intraperitoneal adhesions. Arch Surg 1974;108:849-53.
13. Linsky CB, Diamond MP, Cunningham T, et al. Adhesion reduction in the rabbit uterine horn model using an absorbable barrier, TC-7. J Reprod Med 1987;32:17- 20.
14. Tampakoudis P, Assimakopoulos E, Grimbizis G, et al. Caesarean section rates and indications in Greece: data from a 24-year period in a teaching hospital. Clin Exp Obstet Gynecol 2004;31:289-92.
15. O’Dwyer V, Hogan JL, Farah N, et al. Maternal mortality and the rising cesarean rate. Int J Gynaecol Obstet 2012;116:162-4.
16. Kan O, Gorkem U, Alkilic A, et al. Efficacy of stirae gravidarum extension and localization of predicting intraperitoneal adhesion risk. J Obstet Gynaecol Res 2019; 45:2358-63.
17. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011;205:1-8.
18. Nisenblat V, Barak S, Griness OB, et al. Maternal complications associated with multiple cesarean deliveries. Obstet Gynecol 2006;108:21-6.
19. Lynch CM, Kearney R, Turner MJ. Maternal morbidity after elective repeat caesarean section after two or more previous procedures. Eur J Obstet Gynecol Reprod Biol 2003;106;10-3.
20. Morales KJ, Gordon MC, Bates GW Jr. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 2007;196:461-6.
21. Lyell DJ, Caughey AB, Hu E, et al. Peritoneal closure at primary cesarean delivery and adhesions. Obstet Gynecol 2005;106:275-80.
22. Bamigboye AA, Hofmeyr GJ. Closure versus nonclosure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane Database Syst Rev 2014;8:CD000163.
23. Taylan E, Akdemir A, Ergenoglu AM, et al. Can we predict the presence and severity of intra-abdominal adhesions before cesarean delivery? Gynecol Obstet Invest 2017;82:521-6.
24. Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons: Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril 2008;90:144-9.
25. Placenta accreta spectrum. Obstetric Care Consensus No. 7. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:259-75.
26. Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 2018;218:75-87.
27. Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta acreta: the role of decidua and extravillous trophoblast. Placenta 2008;29:639-45.
28. Bodelon C, Bernabe-Ortiz A, Schiff MA, et al. Factors associated with peripartum hysterectomy. Obstet Gynecol 2009;114:115-23.
29. Knight M, Kurinczuk JJ, Spark P, et al. United Kingdom Obstetric Surveillance System Steering C. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 2008;111:97-105.
30. Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more? BJOG 2004;111:1090-4.
31. Makoha FW, Felimban HM, Fathuddien MA, et al. Multiple cesarean section morbidity. Int J Gynecol Obstet 2004;87:227-32.
32. Soltan MH, Al Nuaim L, Khashoggi T, et al. Sequelae of repeat cesarean sections. Int J Gynaecol Obstet 1996;52:127-32.